Tele-medicine

Where virtual and reality meet in the doctor's office

By Wayne Drash
CNN.com senior editor

A computer-generated, real-time graphic image of a knee joint

ATLANTA, Georgia (CNN) -- In a distant room at the University of Central Florida, a man lies on his back on a laboratory table with a series of wires and electronic sensors hooked up to his right knee. About 400 miles away in Atlanta, engineers and a dozen other people at a technology conference gather around two large television screens that beam back video from the Florida lab.

The crowd is about to witness "tele-medicine," one of the practical examples of technology entering the doctor's office. Medical and educational specialists call it a virtual reality-like advancement that can enable doctors, researchers or medical students to witness procedures from afar via the Internet.

"It's technology like this that's going to save lives, or at least better them," said Alex Latzko, an engineer at last week's Networld+Interop 2000 Atlanta conference, one of the largest gatherings of networking, Internet and telecommunications professionals in the world.

Just what this technology can do became clear as Jannick Rolland, an assistant professor at the School of Optics at UCF, appeared on one of two 32-inch screens mounted for the demonstrations and began explaining what the procedure entailed. Just beyond her sat the man whose knee needed to be scoped.

Moments later, on the second screen, a three-dimensional image of the man's knee popped up, a startlingly detailed outline of his leg, leg bones and knee joint. His knee flexed up and down, his bones levered; it was like watching a real-time, 3-D X-ray.

The hope is that technology like this -- currently being utilized as a research and teaching tool at a limited number of universities -- will become widespread and readily available to doctors in the coming years. Similar tele-medicine technology allows doctors to witness surgeries from remote locations.

'Way cool'

The benefits of tele-medicine are far-reaching. A specialist in Boston could give advice to a doctor in rural America for on-site medical care, or even guide that doctor during a surgery. A medical student could watch a rare procedure that would otherwise be unavailable. Researchers could readily swap and exchange information.

"The need for accurate visualization and diagnosis in health care is crucial," Rolland said in an e-mail after the demonstration. "With the advent of imaging technologies, opportunities for minimally invasive surgical procedures have arisen. Imaging and visualization can be used to guide needed biopsy, laparoscopic, endoscopic and catheter procedures."

"Furthermore, the technology has tremendous potential for training medical students and experts," she wrote.

Internet2 makes remote diagnosis a step closer to reality

Anyone accustomed to viewing grainy images over the Internet would have found the Atlanta demonstration amazing.

The video, streamed over what is known as Internet2, was crystal clear -- an accomplishment made even more amazing by the fact that it was shown on 32-inch television screens.

Expect similar surprises in the future, said Carly Fiorina, who was recently named chairwoman of Hewlett-Packard. The world, she said while delivering the conference's keynote address, is entering the "renaissance of the information age."

The medical demonstration seemed to underscore this "renaissance."

Or, as Latzko put it: "This is way cool."

Working out technical kinks

There are serious issues to be dealt with as tele-medicine becomes more widespread. At the outset of the Atlanta demo, one TV screen blinked and the screen went dark -- a hardware problem -- which sent engineers scrambling.

Within seconds, the problem was fixed and the demonstration continued with few problems.

Yet the mishap and other technical hurdles, Rolland acknowledged, highlights a basic question: Is the technology ready for such crucial use?

"It is not at this time, but we are making tremendous progress by the year," Rolland responded in her e-mail.

How soon until the technology is mainstream?

"As a teaching tool, which will benefit all, it can be implemented within five years," she wrote. "As a mainstream, it will be more likely 10 to 20 years, perhaps sooner."

Paul Morris, the vice provost for information technology at Emory University, said developers of Internet2 -- I2 to its users -- are working to make fully redundant systems to help with the technical kinks. If part of the system crashes, it should be able to switch over to a backup without any noticeable downtime, he said.

There also needs to be a way to set priorities on who gets access to the system, Morris said. For instance, a surgeon needed for remote consultation should get logged on over a student trying to download music, he said.

"Right now, the traffic is all very democratic," Morris said. "You want to be able to prioritize."

Patients, physicians benefit

Researchers and higher education teachers are already using various forms of tele-medicine.

For example, the CareGroup Healthcare System, composed of six hospitals in eastern Massachusetts, uses the Web to let physicians and patients get information.

If a patient plans to undergo a certain surgical procedure, that patient can go to the system's secure Web site and watch video of a similar surgery to get an idea of what to expect. At the same time, the doctor can look at the patient's records.

The site currently gets about 3 million hits per month, said Dr. John Halamka, chief information officer for CareGroup Healthcare System.
"The way clinicians work today, they really need ubiquitous information," said Halamka, who is also an emergency physician at Beth Israel Deaconess Medical Center in Boston.

At Ohio State University, sophisticated and tiny video cameras record laparoscopic surgeries, such as gall bladder removals. That video can then be shown over Internet2 at remote locations to teach experienced surgeons new techniques as well as train residents and medical students.

"We use video for distance education," said Dr. Jerome Johnson of Ohio State's College of Medicine and Public Health during another demonstration at the Interop conference. "It gives medical students a real-time experience that can be shown in an auditorium or all over the world."

A pricey club

Fiber optic cables make Internet2 possible

Unlike the Internet, available to anyone with a computer and modem, Internet2 is more discriminating.

First, it's a collaborative effort led by United States research universities wanting to create more dynamic tools for advanced research and education. There are more than 170 universities across the United States that are members of Internet2, which also has more than 50 corporate members and corporate partners aiding in the development of the system.

The nationwide network supporting Internet2 is known as Abilene, a high-performance backbone network that operates at 2.4 gigabits per second, nearly 45,000 times faster than a 56k modem. The network uses 13,000 miles of fiber optic cable to transmit information to and from its members.

Second, Internet2 is like an exclusive country club: It costs big bucks to join, and the annual fees aren't pocket change.

It costs $25,000 a year to join Internet2 and another $25,000 annually to connect to Abilene. A university then needs to buy or rent the fiber optic line that connects to what is known as a "gigaPoP," which makes Abilene accessible to campuses.

"The principal problem that universities face is money," said Morris of Emory University. "This is expensive technology to deploy."

Emory spent $150,000 on the lines that run only a few miles to Georgia Tech, the home of the gigaPoP in Atlanta, said Morris. Imagine, he said, the cost for schools in rural areas to run lines for miles to the nearest gigaPoP.

"This is very much a medium/long-range investment," Morris said.

The costs, though, seem minimal compared to what the technology offers.

"I do not think that there are strong opposition to the technology in the medical field," Rolland said in her e-mail. "To the contrary, more and more surgeons are looking for enhanced tools to help them in their challenges."